Chapter 1: Insurance Billing Basics

Here comes your favorite part of the day: paperwork. But it does not have to be that bad. In fact, paperwork can be a breeze, especially if you go all electronic.

In this section, we will discuss best practices for dealing with both self-pay clients and insurance companies. This section will provide you the foundation you need to understand how to set up your billing in a private practice and what is required of all involved parties.

Set Clear Expectations from the Get-Go

Whether you have chosen to only accept self-pay clients or you also work with insurance providers, it is important to assign financial responsibility to the client. Be very clear about financial responsibility on your client intake form. If you accept insurance, explain that the client is still responsible for the payment of the services.

You may also include a special note on your intake form that obliges the client to pay for collection fees if the bill is handed over to a collection agency or lawyer. Otherwise, you (as the provider) may end up footing the cost for this service. Explain what you do in case of a bounced check, also.

Create a Standard Payment Policy

Here is how to set the bar in your private practice. In addition to including payment expectations on your intake forms, you should also create an entire payment policy that is freely distributed at the time of sign up. Have it posted on or near your reception desk. Link to it on your website. Your payment policy should be the most accessible form you have in your office.

Create an easy to understand and implement payment policy for all of your clients. With a payment policy, there are no surprises. Clients should know what you expect and when you expect it. Answer the following question:

When is payment due?
Payments are usually rendered at the time of service, but you may also provide payment arrangements depending on your billing structure.

Who is responsible for payment?
Self-pay clients are 100% responsible for payment. Clients who use an insurance plan are responsible for any amount not paid by their insurance provider.

What type of payment do you accept?
Along with cash, explain what other types of payment you accept. Which credit cards do you accept? Do you accept debit cards? What about personal checks?

What about HSA?
We have seen a rise in the use of Health Savings Account (HSA) cards applied as payment for therapy sessions. Some credit card processors are unable to process payments from HSA cards if they are not setup with the 8099 MCC code. Make sure to check in with your credit card processing company before you start accepting payments to ensure you are setup to accept these payments. TheraNest is able to process all HSA cards in application as long as they are MasterCard, Discover, AMEX, or Visa.

What happens if your client does not pay?
If you allow a payment arrangement and do not receive 100% of the payment upfront, what happens if the client does not pay the remaining balance on time? How long do they have to pay? What happens after that time? Will you turn it over to a collection agency? Will the client be responsible for the fee? These all questions to think about before you start accepting patients. Create a policy on how your practice plans on dealing with delinquent payments so you are prepared when the inevitable happens.

Do you charge for missed or late appointments?
Explain your policy for such appointments. Discuss what fees you assess and make sure you to explain this policy to your patients, both verbally and in writing so that there is no confusion.

Do you help submit claims?
If so, explain that while you may offer this as a service to the client, you are not a part of the agreement between the client and the insurance provider and it is the client’s responsibility to clear up any disputes or confusion.

Submitting Claims to an Insurance Company

Here are the best practices for submitting to an insurance company:

Understand who to bill

Your client may have more than one insurance provider. Verify with your client that you are billing the correct insurance provider as the primary, secondary, and so on.

Get your claim in on time

Many insurance companies have a deadline for submitting claims. Often, this deadline is within 90 days of services rendered, but always check and do not assume that all insurance companies use the same deadlines.

Use a clearinghouse

Before submitting to an insurance company, use a clearinghouse to process your electronic claims. This third-party intermediary will “scrub” your claims for common errors and send them back to you to correct. Working with a clearinghouse generally means less rejected claims from the insurance company. We will talk more about this in section three: Clearinghouse 101.

Follow up on unpaid claims

There is no doubt that you are busy, but are you ever busy enough to let unpaid claims fall through the cracks? Make it a habit to follow up on outstanding balances from insurance companies. Check up on invoices that are not paid within 120 days. You may be able to check on the status of outstanding claims entirely online.

Best Practices for Self-Pay Clients

Here are the best practices for working with self-pay clients:

Be clear about your payment policy

This cannot be emphasized enough. Posting a clear payment policy sets expectations and increases your trustworthiness.

Follow up on unpaid balances

Just like with insurance companies, it is crucial to follow up any unpaid balances left by self-pay clients. Make sure you do it sooner rather than later. After 30 days, the chances of getting paid decrease by 50%.

Offer different ways to pay

You will accept cash, but what else? The more payment types that you accept, the greater your odds of appealing to a wider client base.